A simple home-based self-monitoring tool for early detection of hand-foot syndrome in cancer patients

Abstract

Objective: Development of hand-foot syndrome symptoms, which is a common adverse effect of several cancer chemotherapy agents, can result in patient withdrawal from treatment. Its early identification allows appropriate modification of chemotherapy regimens and can avert treatment withdrawal by minimizing the impact on quality of life and duration of discontinued therapy. We sought to develop a simple home-based self-monitoring tool to facilitate reliable early identification of hand-foot syndrome, based on the self-administered quality of life questionnaire hand-foot syndrome-14. Methods: We modified the hand-foot syndrome-14 to create a simple tool with binary responses ('yes' or 'no') for patients to self-evaluate subjective hand-foot syndrome symptoms daily. We evaluated this tool with 187 consecutive, consenting, eligible adult patients attending four centers and treated with capecitabine, sorafenib or sunitinib for various cancers. Univariate and multivariate logistic regression analyses were used to select the items with the greatest discrimination for detecting Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or 3 reactions, which indicate the need to modify the treatment regimen. Results: There were four items that were most strongly associated with Common Terminology Criteria for Adverse Events grade 2 or higher symptoms. 'Pain associated with hand-foot syndrome' was the most strongly associated with moderate hand-foot syndrome. For detecting moderate handfoot syndrome symptoms, the sensitivity was 100.0%, specificity was 94.6%, positive predictive value was 82.6% and area under the curve was 0.98 by a sum of the scores of four-item self-monitoring tool with cut-off value. Conclusions: We present a simple self-monitoring tool that can be used at home with high sensitivity and specificity for identifying grade 2 hand-foot syndrome. In addition, this tool might facilitate selfcare.

How to conduct integrated pharmaceutical care for patients with hand-foot syndrome associated with chemotherapeutic agents and targeted drugs

“…Fortunately, a recent study based on the Japanese HFS-14 proved that the 4 items: 'pain associated with HFS', 'I have difficulty performing everyday actions', 'I have difficulty washing myself or putting on makeup (or shaving)' and 'I take longer than usual to get dressed' are associated with CTCAE grade 2, which is the standard indication for seeking treatment with several drugs. 58 Thus, the modified Japanese HFS-14 scale turned out to be the most simple and effective questionnaire for patients' home-stay self-monitoring at present. Meanwhile, during the entire treatment, patients should be advised to wear loose shoes, socks and gloves, avoid excessive pressure and frequent friction of hands and feet, avoid exposure in the sun and hot water, as well as excessive exercise.…”

Oral hyperpigmentation as adverse effect to capecitabine

“…In advanced cases, the pain may interfere in quality of life, impeding daily activities. In such situation, dose adjustment or even patient withdraw from treatment may be consider 5 .…”

“…Although not being life threatening, HFS can reduce drastically quality of life and result in patient withdrawal from treatment, and its early detection allows choosing between appropriate dose reduction or modification of chemotherapy regimens, which can avert the discontinuation of the treatment 5 . The association of palmoplantar and oral hyperpigmentation as an adverse effect to capecitabine has rarely been described in the literature 1 .…”

Capecitabine Induced Hand-Foot Syndrome: A Systematic Review of Case Reports

“…Health Sciences the hands and feet is observed and uncomfortable erythema occurs during walking and holding objects in Grade 2; painful erythema and swelling are observed in the palms and soles in Grade 3; and a significant increase in the severity of pain with bloating, deep peeling, and ulceration is observed in Grade 4 (10). Patient self-monitoring tools have been developed for the self-evaluation of HFS symptoms by patients (11)(12)(13)(14).…”